Basis for sudden cardiac death prediction by T-wave alternans from an integrative physiology perspective.
Basis for sudden cardiac death prediction by T-wave alternans from an integrative physiology perspective.
复制标题
从综合生理学角度通过 T 波交替预测心源性猝死的基础。
DOI：
10.1016/j.hrthm.2008.11.019
复制
发表时间：
2009-03
期刊：
影响因子：
5.5
通讯作者：
Nearing, Bruce D.
中科院分区：
文献类型：
--
作者：
Verrier, Richard L.;Kumar, Kapil;Nearing, Bruce D.
关键词：
检测t波交替（TWA）的微伏水平已被证明对识别心脏性猝死高危人群是有用的。TWA的机制基础是复杂的，在细胞水平上涉及多种机制，特别是膜电压的不稳定性（即陡峭的动作电位持续时间恢复斜率）和细胞内钙循环动力学的破坏。在系统层面上，影响TWA的综合因素也是多方面的。我们关注三个主要变量，即心率、自主神经系统活动和心肌缺血。临床上，人们对将TWA测试扩展到包括动态心电图监测和运动的兴趣越来越大。前一种方式允许评估日常生活中各种挑衅性刺激的影响，包括昼夜节律因素、精神压力和睡眠状态相关的呼吸和心血管功能紊乱。本文讨论了临床TWA检测的两个主要新兴概念，即TWA水平的定量分析，以补充目前的二元分类方案，以及保留左心室功能的患者的风险分层，这是心脏性猝死绝对人数最多的人群。
Detection of microvolt levels of T-wave alternans (TWA) has been shown to be useful in identifying individuals at heightened risk for sudden cardiac death. The mechanistic bases for TWA are complex, at the cellular level involving multiple mechanisms, particularly instabilities in membrane voltage (i.e., steep action potential duration restitution slope) and disruptions in intracellular calcium cycling dynamics. The integrative factors influencing TWA at the systemic level are also multifold. We focus on three main variables, namely, heart rate, autonomic nervous system activities, and myocardial ischemia. Clinically, there is growing interest in extending TWA testing to include ambulatory ECG monitoring as well as exercise. The former modality permits assessment of the influence of diverse provocative stimuli of daily life, including circadian factors, mental stress, and sleep-state related disturbances in respiratory and cardiovascular function. Two major emerging concepts in clinical TWA testing are discussed, namely, quantitative analysis of TWA level, to complement the current binary classification scheme, and risk stratification of patients with preserved left ventricular function, the population with the largest absolute number of sudden cardiac deaths.
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DOI：
10.1152/ajpheart.00612.2001
发表时间：
2002-02-01
影响因子：
4.8
作者：
Fox, JJ;McHarg, JL;Gilmour, RF
通讯作者：
Gilmour, RF
影响因子：
24
作者：
Kaufman, Elizabeth S.;Bloomfield, Daniel M.;Bigger, J. Thomas
通讯作者：
Bigger, J. Thomas
DOI：
10.1046/j.1540-8167.2001.00759.x
发表时间：
2001-07-01
影响因子：
2.7
作者：
Kon-No, Y;Watanabe, J;Shirato, K
通讯作者：
Shirato, K
影响因子：
5.5
作者：
De Ferrari, Gaetano M.;Sanzo, Antonio
通讯作者：
Sanzo, Antonio
影响因子：
5.5
作者：
Hohnloser, Stefan H.;Ikeda, Takanori;Cohen, Richard J.
通讯作者：
Cohen, Richard J.